Introduction

The COVID-19 pandemic has had a profound and far-reaching impact on a global scale, triggering widespread health, social, and economic upheaval across nations and communities [1]. In fact, Kabagani of the Philippine News Agency (PNA) presented the prevalence of cases in the Philippines which reached to 271,963,258 last December 2021, including 5,331,019 deaths. From December 15, 2021, a total of 8,337,664,456 vaccine doses have been administered. From overwhelmed healthcare systems and unprecedented loss of life to disruptions in daily life and economic instability, the repercussions of the pandemic have been profound and far-reaching. The effects of COVID-19 have reverberated through every aspect of community life, magnifying existing vulnerabilities and necessitating swift and coordinated responses to mitigate its toll. However, many challenges grapple in imposing COVID-19 measures. Loreche et al. found out that an individual’s perception significantly influences the decision to vaccinate and these perceptions are influenced by the dissemination of (mis)information that is magnified by the media, the community, and the health system [2].

As the world grapples with the challenges posed by the pandemic, understanding the dynamics of public willingness to accept and adhere to COVID-19 measures becomes paramount in shaping effective strategies for containment and mitigation efforts. This study offers a new foundation for understanding the psychological effects that influence students' acceptance of COVID-19 measures and provides valuable insights that can inform evidence-based strategies for enhancing community engagement, improving compliance, and fostering resilience amidst the ongoing health crisis. Hence, this study was conducted [3].

The study aims to delve into the factors that shape students' attitudes and behaviors toward COVID-19 measures and how these factors influence compliance and adherence to vaccination within educational settings. By delving into the psychological dynamics, this research aims to enhance understanding of the challenges and opportunities for promoting effective public health strategies among student populations during the ongoing COVID-19 pandemic [4].

This understanding is crucial as it can significantly affect not only the making of plans and interventions but also includes implementation of public health strategies, making the audience feel the relevance and significance of the research.

This study aims to address the following specific questions:

• What constitutes the demographic characteristics of the respondents?

• What is the vaccination status of college students?

• What is the percentage of vaccinated and those who are not?

• What is the extent of students' willingness to be vaccinated?

• What are students' attitudes on COVID-19 measures regarding susceptibility, severity, beliefs, and barriers?

• Does students' attitude on COVID-19 measures significantly influence their willingness to be vaccinated?

Theoretical background

This research study is firmly anchored in the theory of Rosen stock Hochbaum, a renowned scholar who studied and identified factors that predict an individual's health-related behavior and beliefs on their own health conditions. Hochbaum et al. identified several crucial factors that impact health behaviors. These include an individual's perception of their vulnerability to sickness or disease (perceived susceptibility), their belief in the severity of the consequences, the potential positive outcomes of taking action (perceived benefits), the perceived obstacles to taking action, exposure to factors that motivate action (cues to action), and their confidence in their ability to succeed (self-efficacy). This theoretical foundation lends scientific rigor and credibility to the study, making the audience feel the robustness of the research [5].

Applying the same theory, several studies like that of Jones et al.; Zewdie et al.; Anuar et al. and Subedi et al. provide robust evidence to consider individuals' health beliefs when designing an effective preventive program by highlighting the benefits of precautionary actions and also focus on eliminating barriers perceived by the public.

Hence, this study assumes that health behavior is activated based on perceptions of threats, susceptibility, and benefits of engaging in protective behavior. This requires careful attention to how these perceptions might be structured and activated. The researcher, therefore, presumed in this study that the belief of respondents to be exposed to the virus and the possible negative consequences it may bring them, as well as the goodness of taking the vaccine, affects their likelihood of availing of the government's program for immunization. It is in this context that the study evolves.

Materials and Methods

The study was conducted utilizing a quantitative design. The null hypothesis statements that "Students' attitudes on COVID-19 measures do not significantly influence students' willingness to be vaccinated” was tested at a 0.05 level of significance. The statistical tools used to describe the general characteristics of the respondents include frequency, percentage and mean, while Binary Logistic Regression (BLR) was utilized to examine the effect of students' belief about COVID-19 virus and their willingness to be vaccinated as preventive COVID-19 measures.

The research instrument used in this study is a survey questionnaire adapted with consent from the research of Dr. Giao Huynh et al. By applying Slovin's formula, the researcher was able to identify the sample size to represent the 5237 students officially enrolled for the school year 2020-2021 [6].

Due to the inevitable existence of the COVID-19 virus and the restrictions imposed by the Philippine government to conduct a face-to-face survey, the researcher gathered the data using an online survey. A simple random sampling technique was then applied to give each students a chance to participate as respondents to the study.

Results and Discussion

The demographic characteristics of the respondents

This section offers a comprehensive insight into the study's outcomes concerning the demographic profile of the respondents, encompassing aspects such as age, gender, and educational level. It aims to address the primary research inquiry: "What constitutes the demographic profile of the respondents? The demographic profile of the respondents as to their age is illustrated in Table 1 below. The data reveals a predominant presence of individuals in their adolescent stage, with 387 respondents, constituting nearly 84%, falling within the age bracket of 17-21 years.

Table 1. Frequency distribution of respondents as to age (N=462).

The survey data in Table 2 unveils that out of the 462 respondents, the majority, comprising 324 individuals, are female, representing 70% of the surveyed population. This disparity underscores a notable prevalence of female respondents in the survey, surpassing the number of male respondents.

Table 2. Frequency distribution of respondents as to sex (N=462).

The frequency distribution of respondents by educational level is presented in Table 3 below. Based on the data, it is evident that most respondents were freshmen, whereas a minority of them were in their senior year.

Table 3. Distribution of respondent frequencies by year level (N=462).

Vaccination status

This section aims to illuminate readers on college students' vaccination status, distinguishing between those who have been vaccinated and those who have not. Furthermore, it provides insights into their receptiveness towards government vaccination initiatives. This section addresses the following research inquiries: What is the vaccination status of college students, and what is the percentage of those who have been vaccinated and those who have not? What is the extent of students' willingness to be vaccinated?

As depicted in Table 4, a significant proportion of respondents, amounting to 393 individuals or 85% of the total sample size of 462, were identified as not having received vaccination at the time of data collection. The data presented in the table underscores a substantial disparity among college students in terms of those who have accessed government-provided vaccines and those who have not [7].

Table 4. Frequency distribution on vaccination status (N=462)

Acceptance/willingness to be vaccinated

Table 5 presents the frequency distribution of respondents' attitudes towards vaccination. The data indicates that 65% of respondents, 299 individuals, are positively inclined to avail the vaccine. Conversely, 155 respondents, comprising 35% of the total sample size of 462, express a negative stance towards vaccination.

During the study, it appears that there are still respondents who still need to establish confidence in the government's vaccination program. The lack of comprehensive and

accessible information during the start of the pandemic became a predictable factor contributing to the reluctance of young adults to engage in the program. Another factor that may hinder the response to the government vaccination program is the dissemination of inaccurate information regarding the effects of vaccines.

In the study of Jose et al., vaccine hesitancy arises from a combination of factors, including a lack of confidence or trust in vaccines or healthcare providers, a perception that the benefits or necessity of vaccination are insufficient, and the inconvenience or unavailability of vaccines, often due to affordability issues.

Table 5. Frequency distribution of respondents as to acceptance/favorable to vaccination (N=462).

The notable contrast between the proportion of respondents embracing vaccination, as illustrated in Table 3, and those who have already been vaccinated, as depicted in Table 2, presents an opportunity to delve into the reasons behind the delay in adhering to the government's vaccination program. As Allen et al. pointed out, by addressing the root causes of medical mistrust, we can encourage more people to vaccinate against COVID-19 using the currently available vaccines and establish a solid basis for future vaccination campaigns. In their study, Olawa et al. expressed the same idea when they expressed the need to implement culturally sensitive awareness programs as crucial for addressing misconceptions surrounding COVID-19 vaccination. Exploring this disparity can aid the government in refining its delivery mechanisms to ensure tertiary education students' health and safety [8].

Students attitude on COVID-19 measures

This section examines respondents' agreement level regarding statements that assess perceived susceptibility, severity, benefits, and barriers to COVID-19 measures. Table 6 illustrates the average distribution of beliefs concerning perceived susceptibility and severity. The results reveal that respondents express significant concern about contracting COVID-19, as shown by an average rating of 3.82. This trend indicates confidence among those who took the survey that they will not be infected with COVID-19, as indicated by their disagreement with this item and reflected by a mean score of 2.33.

Table 6. Mean distribution on the attitude of students in COVID-19 measures in terms of perceived susceptibility and severity (N=462).

Table 7 below presents the respondents' beliefs regarding the perceived benefits and barriers associated with COVID-19 immunization. The results reveal a consensus among participants on the effectiveness of vaccination in preventing COVID-19 transmission and protecting others.

Additionally, respondents indicate decreased concerns about severe illness following immunization. Nonetheless, some participants harbor reservations about the potential adverse effects of the COVID-19 vaccine and express apprehensions about the vaccination costs.

The above findings are similar to the result of the study conducted by Bennet et al., who proved that taking vaccines reduces the problem of COVID-19. Most of the respondents in the study by Caple et al. indicated their willingness to be vaccinated. It emphasized that respondents' perceptions of high susceptibility, high severity, and significant benefits were good predictors of vaccination intent.

Table 7. Mean distribution of the attitude of students in COVID-19 measures in terms of perceived benefits and barriers (N=462).

Predictors of acceptability for vaccination

This section provides an understanding of whether or not students' belief toward COVID-19 measures significantly affects their willingness to be immunized. It shall also determine what factors strongly and significantly predict students' likelihood of being vaccinated. It shall specifically answer the question: Does students' attitude on COVID-19 measures significantly influence their willingness to vaccinate?

The Table 8 displays the Binary Logistic Regression (BLR) analysis results to predict vaccination acceptance. The data illustrates the coefficients, standard errors, Wald values, degrees of freedom, statistical significance levels, and odds ratios associated with the predictors. The analysis indicates that perceived susceptibility and severity significantly impact vaccination acceptance, with an odds ratio of 13.578. Conversely, perceived benefits and barriers negatively affect vaccination acceptance, with an odds ratio of 0.309. The constant term in the model is also statistically significant."

As a result, the null hypothesis, which posits that attitudes toward COVID-19 measures have no significant impact on vaccination acceptance, is rejected. This suggests that individuals' perceptions of the risks associated with COVID-19 in the absence of preventive measures may increase their susceptibility. Furthermore, the perceived benefits of vaccination significantly influence their decision-making, encouraging them to avail themselves of the vaccine [9].

These results align with Hochbaum and Rosenstock's theories, as Keller et al. (n.d) cited. According to their frameworks, an individual's perception of susceptibility to a particular illness or condition and their confidence in the effectiveness of recommended health practices determine their likelihood of adopting those behaviors." "The government's vaccination initiative has significantly impacted the likelihood of individuals getting vaccinated. Specifically, a substantial increase of 2.606 in vaccination likelihood is attributed to respondents' perceptions of susceptibility and severity. At the same time, a decrease of -1.176 is associated with perceived benefits and barriers related to the COVID-19 vaccine.

These results would mean that respondents' primary predictor of vaccination acceptability is their perception of susceptibility and severity concerning COVID-19. This conclusion is consistent with a study conducted by Giuliani et al. They pointed out that factors such as trust in the vaccine, the number of vaccinations received, and the belief that COVID-19 presents a greater severity than the common flu are linked to positive vaccination intentions.

Table 8. Binary Logistic Regression (BLR) in predicting acceptability for vaccination.

Conclusion

A significant number of respondents who participated in this study are adolescents, and the majority are female first-year students. Moreover, many respondents have yet to undergo vaccination but are willing to be immunized. The respondents believe that COVID-19 vaccination is beneficial as it can protect them from susceptibility and severity of the virus. Hence, it can be deduced that an individual's willingness to be vaccinated is greatly influenced by their perceptions of susceptibility and severity of the virus.

Recommendations

In light of these conclusions, the following recommendations are proposed:

• Implement targeted educational campaigns toenhance college students' awareness of theimportance of COVID-19 vaccination, focusing onaddressing misconceptions and fostering informeddecision-making.

• Establish accessible vaccination clinics orcampaigns close to educational institutions tofacilitate ease of access and uptake among students.

• Encourage open dialogues and discussions withinthe college community to address vaccination-related concerns and barriers, fostering a supportiveenvironment conducive to informed decision-making.

• Collaborate with healthcare professionals andstudent organizations to organize informationalsessions or workshops to address specific concernsand queries regarding COVID-19 vaccination.

Individuals' inclination to receive a vaccine is significantly impacted by their perceptions of their vulnerability and the seriousness of the virus. Therefore, educational interventions in various colleges and universities must prioritize improving knowledge regarding the advantages of vaccination and providing accurate information about the obstacles that lead to students' reluctance to immunization. This can be achieved through disseminating mass media messages and cues, as well as through the active involvement of government healthcare workers in promoting vaccine acceptance.

Acknowledgment

Dr. Marvien Maraggun Barrios wishes to express gratitude to Dr. Riza Rhea Ringconada for her diligent assistance in the statistical analysis. The students as respondents who have officially enrolled at Cotabato Foundation College of Science and Technology (CFCST) for the academic year 2020-2021. To her mentor for diligently reviewing her work without tiring. To her family for their abundant support, and to the Divine Creator for the protection and bestowing of the precious gift of life.

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